| NPI | 1669700654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NY 054544) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58775) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2010-04-25 |